1. Field of the Invention
I, Enrico Nicolo, have developed improvements relating to the field of surgery and, particularly, my invention relates to a hollow viscus (intestine, vascular, urinary, etc.) resection and reconstruction device for hollow viscus surgery.
2. Background Information
Various types of surgical fastener applying instruments are known for the application of surgical fasteners to tissue. A common type of surgical fastener is a surgical staple. Surgical stapling instruments typically have a mechanism for firing a plurality of staples from a staple holding cartridge and an anvil disposed opposite the staple cartridge against which the staples are formed. Such instruments include, for example, linear staplers, which typically apply one or more parallel rows of staples, and circular staplers, which typically apply one or more concentric/circular rows of staples. In use, the surgeon will place tissue between the staple cartridge and anvil and, by firing the instrument, cause the staples to become clenched to the tissue.
Circular staplers are known and have been successfully used in surgical procedures for many years. Commercially available instruments include: the CEEA® circular stapler, manufactured by United States Surgical Corporation, Norwalk, Conn., and the ILS®. circular stapler manufactured by Ethicon, Inc., Blue Ash, Ohio. Various embodiments of circular staplers have been disclosed in U.S. Pat. Nos. 4,576,167; 4,603,693; 5,005,749; and 5,119,983. These instruments are typically indicated for use in gastric and esophageal surgery wherein tubular organs are joined to other anatomical structures.
The techniques of resecting a segment of the colon or intestines and an anastomosis of the cut ends are common procedures where a segment of diseased bowel must be removed for reasons such as inflammation, oncological process, obstructions, bleeding, perforation, trauma, etc. A conventional procedure for resection and anastomosis operates as follows. The first step is mobilization of a segment of the intestine to be resected. Mobilization is achieved by freeing the intestine from its cavity attachment and is then followed by separating its blood supply. The mobilization can be conducted laparoscopically or through opening the peritoneal cavity. Second, resection of the segment to be removed follows the mobilization procedure. Following the resection of the segment to be removed, the remaining ends of the bowel are anastomized to guarantee the continuity of the intestinal track. In an intestinal end-to-end anastomosis, a portion of the intestinal tract is removed (i.e., due to the presence of disease, such as cancer) as noted and the remaining ends are rejoined by using a circular stapler. To join the tubular structures, one end of the intestine is secured about an anvil and the other end of the intestine is held in place adjacent a staple cartridge. Preferably, the anvil has a shaft that is removably connected to the instrument. Once the anvil shaft is secured to the instrument, the anvil is drawn into close approximation to the stapling cartridge. The instrument is then fired to cause the staples to pass through tissue of both organs and become formed against the anvil. During the firing step, a circular knife is advanced to cut tissue inside the staple line, thereby establishing a passage between the organs. After firing, the instrument is typically removed by withdrawing the anvil through the staple line, after which the surgeon will carefully inspect the surgical site to ensure a proper anastomosis (joining) has been achieved.
In a further circular stapling example, U.S. Pat. No. 5,392,979 discloses a suturing apparatus which permits the anvil to be attached to, or detached from, the head with comparative ease, but in which the anvil is no longer detachable from the head if the distance between the two members has reached an optimal value for anastomosis. Then, a safety mechanism is released, whereupon it becomes possible to fire the staples. An indicator is used to provide a visual signal for the surgeon to know an optimal value of the head to anvil distance. A similar type of suturing apparatus is described in U.S. Pat. No. 5,205,459.
In addition to the above-described prior art, the following patents can be considered:
U.S. Patent Documents
U.S. Pat.No.Issue DateInventorU.S. Classification3,638,652February, 1972Kelley227/1794,615,474October, 1986Strekopytov et al.227/19 4,817,847April, 1989Redtenbacher et al.227/19 5,104,025April, 1992Main et al.227/19 5,197,648March, 1993Gingold227/19 5,411,508May, 1995Bessler et al.227/19 5,441,507August, 1995Wilk606/1395,868,760February, 1999McGuckin, Jr.227/1796,050,472April, 2000Shibata227/1796,119,913September, 2000Adams et al.227/1766,126,058October, 2000Adams et al.227/179
All of the prior art recognizes two types of existing staplers, namely, linear and circular. The identified prior art suggests that present stapling devices generally include GIA and EEA staplers which can be used to transect tissue in linear and circular fashions, respectively, with subsequent anastomosis with staples. The prior art suggests that the linear GIA is relatively versatile. The prior art further notes that the EEA is primarily suited for lower colonic circular anastomosis after a lesion has been surgically removed (via laparotomy or laparoscopically) or during a colostomy take-down procedure. Further examples of prior art can be found in U.S. Pat. Nos. 5,156,614; 5,170,925; 5,172,845; 5,180,092; 5,188,274; 5,188,638; 5,197,648; 5,197,649; 5,217,472; 5,219,111; 5,220,928; 5,221,036; and 5,242,457.
The present invention relates more particularly to the field of the circular staplers. The existing circular staplers do not match the shape of the hollow lumen, such as the colon. The colon, in the relaxed state, is essentially collapsed and even in the distended form does not form a circle. The anastomized lumen of the prior art is going to be a more unnatural circular state. The presence of scar tissue will hinder the ability of the anastomosis site from returning to the original shape of the lumen. The present invention attempts to address this problem.